Online Application

Student's Name:
Street Address:
City:State:Zip:
Telephone (include area):E-mail:
MU or MCTC 901x or 942x Number:Date of Birth:
 
High School:
Address:
City:State:Zip:
High School Phone:HS GPA:
SAT Score (combined)ACT Score (combined)ACCUPLACER Score
 
I have completed the Free Application for Student Federal Aid: Yes No
Check the College/University you plan to attend:
Marshall University Marshall Community & Technical College Don't know yet
Have you applied to this school? : Yes No
Have you been accepted? : Yes No Haven't heard
Anticipated major or area of study
Previous college experience: (list when and where, and attach transcript):
Previous high school or college math classes:
Previous high school or college science classes:
Citizenship:I am a US Citizen I am NOT a US Citizen
If selected to be a Trailblazers Scholar, I am able to participate in program activities outside of class (estimated commitment of 3 hours per month during school year and an annual summer 3–day workshop)
Number and description of dependents (children and/or adults). Note: For someone within your household to qualify as your dependent, he or she must be listed on your tax return as a dependent.
1. Legal Name:Birthdate:
   Relationship:
2. Legal Name:Birthdate:
   Relationship:
3. Legal Name:Birthdate:
   Relationship:
4. Legal Name:Birthdate:
   Relationship:
5. Legal Name:Birthdate:
   Relationship:
6. Legal Name:Birthdate:
   Relationship:


Contact Information

Dr. Elizabeth Murray

Department of Integrated Science &
Technology @ Marshall University
Huntington, WV 25755
Phone: 304 696 3515
Email: murraye@marshall.edu

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